World Neurosurg
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Comparative Study
Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Comparing to Pedicle Subtraction Osteotomy.
Posterior column osteotomy (PCO) has been used for the correction of various spinal deformities. However, little evidence is available regarding the effects of multilevel PCO in adult spinal deformity (ASD) surgery. This study aimed to show the usefulness of PCO in rigid ASD surgery by assessing radiographic and clinical outcomes. We also aimed to assess the corrective potential of multilevel PCOs compared with a single-level pedicle subtraction osteotomy (PSO). ⋯ Multilevel PCOs for the correction of rigid ASD were slightly superior to PSO, regarding clinical outcomes. Radiographic outcomes were similar between groups. Thus, multilevel PCOs may be a viable option for the treatment of rigid ASD with a mobile segment.
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Four layers of ligamentous stabilizers comprise the craniocervical junction, and the second layer is composed of apical and paired alar ligaments. The purpose of this study is to establish the tensile strength of the alar ligaments for better understanding the implications that can arise from trauma and other pathologies in the craniocervical region. ⋯ Further studies will be necessary to determine their importance as secondary stabilizers and measure their ability to support similar forces when subject to rotation and lateral bending forces, as well as with flexion-extension.
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Previous studies firmly proved that an irregular aneurysmal shape was associated strongly with intracranial aneurysm (IA) rupture, but it is unclear how irregularly shaped IAs form. We aimed to identify the factors related to irregular shape of IAs. ⋯ Location at a bifurcation, an increased aneurysm size, and greater aspect ratio are significant independent factors associated with an irregular shape in unruptured IAs but not with smoking status, hypertension, hyperlipidemia, or diabetes mellitus.
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It is expected that anatomic variations in the circle of Willis have a direct effect on blood flow in the internal carotid artery. Rupture of the lenticulostriate artery of the middle cerebral artery 1st segment (M1) is the most common cause of putaminal intracerebral hemorrhage (ICH), and we hypothesized that this could be related to the anatomic variations of the circle of Willis and the predominance of the anterior cerebral artery 1st segment (A1). ⋯ It was concluded that putaminal ICHs occur more frequently on the side of the dominant A1 segment. This information can help an understanding of the mechanism of putaminal spontaneous ICH development and may even assist in the treatment of ICH.
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The rationale for treatment of dural arteriovenous fistulas (dAVFs) without cortical venous reflux is symptomatic resolution. Most studies of dAVF treatment, including those for stereotactic radiosurgery, have focused on angiographic obliteration instead of clinical symptomatic outcome. ⋯ Rates of clinically significant symptomatic improvement/resolution of symptoms referable to "low-risk" dAVFs are even greater than their angiographic obliteration rate, an important factor in patient counseling and when considering the optimal treatment approach for these dAVFs.